Difficult diagnosis of a double omental hernia that led to extensive small bowel infarction

A 47-year-old female complained of abdominal pain in the epigastrium for about 2 h after a meal. At the initial abdominal radiograph, there were no findings of remarkable bowel loops. On the following day of hospitalization, the pain became worse; moreover, it could not be controlled by medicine. Also, a dilated bowel loop was detected on the imaging studies. When exploring the peritoneal cavity, we found a strangulated small bowel that protruded through the lesser omental sac within the defects of the gastrocolic or gastrohepatic ligaments. After performing manual reduction, the restoring viability of herniated small bowel failed; consequently, extensive small bowel resection was mandatory. Herein we reported a case of extensive small bowel hemorrhagic infarction due to a double omental hernia that was not diagnosed at the time of visiting the emergency department.